A Top Expert’s Recommended Vaccinations for Adults

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

How important are vaccines? Just look back to the 19th century and you’ll see proof of their effectiveness. Many illnesses that killed our great-great-grandparents’ peers are almost nonexistent today.

“Today, we take vaccines for granted, but parents in the United States used to worry their child might die of whooping cough, be paralyzed by polio or die of meningitis,” says Sandra Adamson Fryhofer, MD, a board-certified internal medicine specialist and member of the American College of Physicians’ Adult Immunization Technical Advisory Committee.

“There’s been almost a 100% reduction in diseases like smallpox, diphtheria and polio in this country, compared to before these vaccines were available,” she adds. “And vaccines aren’t just for kids; adults need them too.”

In this edited exclusive interview, Dr. Fryhofer discusses which vaccines women and children need and when to get them.

What would you say to a woman who asks, “If most of the population is already immunized against diphtheria, polio, smallpox, the mumps and meningitis, why do I need vaccines too?”Immunizations will keep you from getting sick. The recent epidemics of whooping cough in California and measles outbreaks we’re seeing [in the U.S.] and Europe are evidence the population is not entirely immunized.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

Vaccines work because of “herd immunity:” When the majority of people in a community are immunized against a disease, it reduces the opportunity for an outbreak and thereby protects most members of that community from contracting the disease.

But for herd immunity to work, about 90% of the population needs to be vaccinated.

Everybody over 6 months old should get a yearly flu shot — not just to protect that person but also those around them, particularly babies.

When pregnant women get a flu vaccine, it protects the baby from catching the flu within the first 6 months of life by 63% and also reduces the risk of fever and respiratory infection in mom and baby.

The Tdap [tetanus, diphtheria and pertussis] vaccination is a family affair. There’s been a resurgence of pertussis infections recently, and we’ve seen [babies die].

A Tdap booster is recommended for adolescents, adults and now for patients over 65.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

At the 2011 ACIP [Advisory Committee on Immunization Practices] meeting, the [Tdap] vaccine was recommended for pregnant women in late second or third trimester, with the assumption that it will provide some protection to babies until they’re old enough to be immunized.

What are other recommended vaccinations?
One of the latest is the meningococcal booster for kids [which protects against meningitis]. When first developed, we thought it would last 10 years, but now we know it [offers] just five [years of protection]. So we recommend that kids get a booster shot. Kids need two doses of meningococcal vaccine.

[Previously unvaccinated college freshmen should receive one dose if they plan to live in a dorm. Some adults may also require the meningococcal vaccine due to occupation, traveling to certain parts of the globe or other reasons listed in the CDC’s adult immunization guide.]

At age 65, you need a pneumonia shot — even younger for some people, such as smokers or asthmatics.

If you were born before 1957, you’re considered to be immune to measles and rubella.

If you’re not immune or you’re a health-care worker [and therefore may be exposed to patients with those viruses in the workplace], get the MMR [measles, mumps and rubella] shot.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

This is a live-virus vaccine, so if you’re a woman of childbearing age, you shouldn’t get pregnant within four weeks of getting the [MMR] shot. The same goes for the chicken-pox vaccine. You don’t want to get pregnant for 4 weeks after getting the shot.

You need a tetanus booster every 10 years, but that’s covered in the Tdap.

What about vaccine recommendations for overseas travel? If you’re going to a developing country, first check out the CDC’s Traveler’s Health section or talk to your internist [about which adult immunization is required for your destination].

Adults traveling to other countries, particularly developing countries, will need the hepatitis A vaccine. For the childhood vaccination schedule, now they’re recommending two doses [of hepatitis A vaccine] for all children at age 1. Some teens might have missed out on that [because the vaccine wasn’t yet recommended for infants when they were that age].

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

Children and adolescents should also be vaccinated for hepatitis A if they:

Travel anywhere, except the United States, Europe, New Zealand, Australia, Canada or Japan

Have chronic liver disease

Abuse drugs

[Will] be in close personal contact with an international adoptee from a country where there’s a risk that the [adoptee] might have hepatitis A

Once you get the hepatitis A and B series [hepatitis A and B vaccines are often combined, but may be administered separately], you should be immune for life.

Sometimes you’ll need a typhoid vaccine, which lasts only two years.

Adults traveling to developing countries also need a one-time booster of the polio vaccine and a yellow fever vaccine, which will protect you for 10 years.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

Are there any benefits or drawbacks to receiving simultaneous immunizations?You can get most vaccines at one time. The benefit is convenience. The downside is your arm will be a little sore.

What are typical reactions to an adult immunization?The most common are local side effects – pain, redness, swelling at the injection site.

With some vaccines, you can get a little headache, fatigue, muscle aches, low-grade fever [and] just feel a little bit under the weather.

With nasal flu vaccine, which is given as a nasal spray, some people experience a runny nose, nasal congestion, headache, fever and sore throat.

Can vaccines pose health risks to people with serious allergies?Some people might be allergic to a vaccine component, like gelatin.

In the past, egg allergies were a contraindication to a flu shot, but now people with an egg allergy can get [it] because studies have shown it’s basically safe and the vaccines have a very low amount of egg protein.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

Some patients, [who] said they had [bad reactions to] tetanus shots years ago, have mentioned horse allergies. Warn [your doctor] if you’d had something like that in the past.

Is it dangerous for people with suppressed immune systems or autoimmune diseases to receive vaccinations? It depends on the type of vaccine. Inactivated “killed” vaccines like the flu, pneumonia, meningococcal and hepatitis A and B shots are safe.

But they should not get live-virus vaccines like chicken pox, MMR or shingles. They can get the flu shot, which is a killed vaccine, but [not] the nasal flu vaccine. [That’s because the nasal flu vaccine is a live-virus vaccine and just like it sounds, live-virus vaccines contain a small amount of the live, but weakened, virus that could cause infection in people with compromised immune systems.]

Can certain medications interfere with a vaccine’s effectiveness?Antivirals can interfere with the nasal flu vaccine, so you shouldn’t [have] the nasal flu vaccine until you’ve been off any antivirals for 48 hours. Then don’t take antivirals for two weeks after receiving the nasal flu vaccine unless medically necessary [because] or the vaccine may not work.

It’s similar to the shingles vaccine: Antivirals like acyclovir, famcyclovir and valacyclovir are effective against the herpes family of viruses, which includes shingles. So make sure you’re off those antivirals for at least 24 hours before receiving the shingles vaccine and don’t take the antivirals for 14 days after that.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

Is it rare for a vaccine not to work? It can happen. Some people’s immune systems don’t respond as well. That’s why we now recommend two doses of MMR and chicken pox vaccine.

Also, if the vaccine isn’t handled properly and kept refrigerated or frozen as it should be, it may not retain its potency.

Which adult immunization should a woman get before trying to become pregnant?Making sure you’re up-to-date on your vaccinations should be part of your pre-pregnancy planning. You don’t want to get one of these infections while you’re pregnant.

Definitely get a flu shot if you’re pregnant.

Who should get the HPV vaccine and why?The HPV vaccine Gardasil, which is a quadrivalent [meaning it targets four human papillomaviruses — types 6, 11, 16 and 18], is approved for males and females age 9-26.

The Cervarix HPV2 vaccine is a bivalent, protecting against two types of the HPV virus — types 16 and 18. It is approved for females age 9-26.

The HPV virus types 6 and 11 cause 90% of cases of genital warts. Types 16 and 18 cause 70% cases of cervical cancer and are also linked to vaginal, vulvar, oropharyngeal [in the upper part of the pharynx], penile and anal cancers.

Which vaccines do women need? How often? A leading internist answers your most common questions about adult immunization...

These vaccines work best when given before exposure to the virus.

Any vaccine breakthroughs you’re excited about?More companies are interested in making vaccines – 6 or 7 companies now make flu vaccines.

A malaria vaccine is on the horizon. A prostate cancer vaccine is under study.

As time goes on, we’re going to see more vaccines, so people don’t have to suffer.

Women’s Health: How Much Do You Know?
As a woman, your health concerns are as unique as your body. How you take care of yourself has a huge impact on your future, affecting everything from your ability to have children to your risk of heart disease. There’s no substitute for good health, and when it’s gone, it’s often gone for good. Don’t let it pass you by. Test your smarts with this women’s health quiz.

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